Discussing Uncertainty Without Losing Trust
- Anxiety
- Communication Barriers
Editorial information
Supporting research and practice sources are identified in the article. The publication date is not an evidence-review date; clinical reviewers and review dates will be credited only when documented.
Explain what is known, what remains uncertain, and how a plan will be reviewed—without promising certainty that medicine cannot provide.
Uncertainty is part of clinical work. Yet patients may hear an unexplained "we don't know" as dismissal, while clinicians may feel pressure to sound more certain than the evidence allows.
Separate the known from the unknown
State what the available findings support. Then name the specific uncertainty: the diagnosis, likely course, magnitude of a benefit, or a test's limitations. Avoid treating all uncertainties as equivalent.
For example: "The examination makes X less likely, but it cannot rule out every cause. These are the possibilities we are watching for."
Connect uncertainty to a plan
Describe what information could change your assessment, whether additional tests are reasonable, and when the situation will be reviewed. Safety-netting is especially important when initial testing is inconclusive. Give individualized warning signs, whom to contact for urgent help, and what the patient should do if an expected test result or follow-up update does not arrive by the agreed time.
When discussing options, explain absolute risks and benefits where reliable estimates exist and say when a number does not apply precisely to this person. Avoid spurious numerical confidence.
Invite the patient's priorities
Ask what the uncertainty means to the patient. Does it affect work, family responsibilities, symptoms, anxiety, or willingness to wait? Shared decision-making combines evidence with preferences; it is not merely transferring uncertainty to the patient.
A short conversational structure
- "Here is what we know."
- "Here is what we cannot determine yet."
- "Here is what might change the assessment."
- "Here is our next step and review date."
- "What worries you most about the uncertainty?"
Adapt the language to the person's needs, emotional state and preferred level of detail.
Evidence and further reading
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